NAC616B.7773. Claims.

     1. Except as otherwise provided in NAC 616B.779, the Board will approve or disapprove, in whole or in part:

     (a) Each claim made against the Account by an association, if the claim is completed by the association pursuant to the requirements set forth in this section; and

     (b) Any expenses of the association related to each such claim that the Administrator has verified pursuant to the provisions of NAC 616B.707.

     2. To submit a claim to the Board, an association must:

     (a) Serve the claim, in writing, to the Administrator;

     (b) Include with the claim a completed copy of the form entitled “D-37, Insurer’s Subsequent Injury Checklist” that is prescribed by the Administrator;

     (c) Organize the claim in the manner prescribed in Form D-37 and number each of the pages in the claim sequentially; and

     (d) Include with the claim all information which is necessary to establish that the claim should be paid from the Account. Such information must include, without limitation, the medical records of the injured employee who is the subject of the claim.

     3. A copy of Form D-37 may be obtained from the Administrator at no cost.

     4. A claim shall be deemed to be complete 15 days after the date that the claim is served to the Administrator pursuant to subsection 2, unless the Administrator serves notice to the association that the claim is incomplete pursuant to subsection 6.

     5. A claim is incomplete if the claim:

     (a) Does not include a completed copy of Form D-37;

     (b) Is not organized in the manner prescribed in Form D-37 or contains one or more pages that are not numbered sequentially with all the other pages in the claim; or

     (c) Does not include information that, in the discretion of the Administrator, is necessary for the Administrator to make a recommendation to the Board pursuant to NAC 616B.7777.

     6. If a claim is incomplete, the Administrator may, not later than 15 days after the date that the claim is served to the Administrator pursuant to subsection 2, serve notice, in writing, to the association that the claim is incomplete. Such notice must include a statement that sets forth the deficiencies in the claim. If the Administrator serves notice that the claim is incomplete, the Administrator may retain the claim or return the claim to the association.

     7. If the Administrator serves notice to the association that a claim is incomplete pursuant to subsection 6, the claim shall not be deemed to be complete until the Administrator determines that the association has corrected the deficiencies in the claim. If the association fails to correct the deficiencies in the claim and the claim has not been returned to the association, the Administrator may retain the claim or return the claim to the association.

     8. The provisions of this section do not affect the authority of the Administrator to obtain additional information related to the claim from the association or any other source after the claim is deemed to be complete.

     (Added to NAC by Bd. for Admin. of Subsequent Injury Fund for Ass’ns of Self-Insured Pub. or Private Employers by R215-97, eff. 8-19-99)